Building NHS Assets with Communities
“We need systems that support and develop asset-based community developments emphasising the strength of a community working together to solve its problems”
The NHS Alliance offer great insight into the needs of the NHS, a focus on communities and developing and supporting the assets that they already hold.
“Primary care providers themselves – general practice, community staff, pharmacists and others – will need to coordinate their initiatives to provide better local health in liaison with local Health and Wellbeing Boards and Clinical Commissioning Groups”
The NHS contracts with four groups of healthcare professionals to deliver much of the primary healthcare. That is right – four – general practice, community pharmacy, optometrists and dentists. This represents a significant asset within our communities. There are approximately 11,000 GP practices, 11,000 community pharmacies as well as a large number of optometrists and dentists working in their practices.
There are two things that links all of these contractors together – their location and their history. They are right at the heart of the communities they serve. And their relationship with their communities may go back many decades serving several generations of their local populations.
So why don’t we concentrate our efforts and investment in these community assets? The main answer is lazy commissioning and there is an urgent need to change this. It is far too easy to react to a problem or issue by commissioning another layer of care. I am not one to support Roy Lilly’s assertion of needing a ‘delete button’ in commissioning. It would not be so necessary if wehad a ‘don’t build’ button. But it is a reflection of the ‘quick fix’ society that we live in. Rather than think hard about the problem, it is easier to jump to commission something new and perhaps innovative and exciting. It is not ‘sexy’ to suggest that we should go back to basics and do more of what we do well and correct faults. If you are failing a performance indicator – just throw some cash at it and fix it. The new services however often are more expensive and deliver yet another layer of complexity. In fact they often cause damage to the existing community assets and additional confusion within the community. It has got to stop – layers need to be deleted and we must invest in our existing assets.
Patients often want what they have to work better and to deliver more. It is simpler that they require not additional complexity. Where patients are looking for a one stop shop – or at least to understand which shop to visit for a solution we give them a multiple of providers and contact points. The NHS Alliance has this right as well:
“The strength of primary care is its first contact with patients”
Here are some suggestions for the new commissioners:
- Know your assets. All commissioners should visit their providers. It’s like walking the floor in a factory. Listen to them and understand how they interact with their communities. Talk to the communities and visualise the potential that they have and the value they could deliver
- Understand your population’s habits. All of the primary care contractor services are already located in the heart of communities. There is a need to understand who goes where and for what reason as well as who would be willing to go where. If you are talking about post-natal depression then remember that mums buy all sorts of things from community pharmacy on a regular basis. What commissioners call ‘hard to reach populations’ and ‘vulnerable populations interact with Healthcare Professionals in the community pharmacy.
- Understand your contracts. There should be an aim for ‘contract plus’ delivery. It is important to ensure that contractors deliver to their contract, but ask what you can do or what can you support that drives service delivery over and above what they are contracted to do.
- Co-locate. Before ever building, consider what services can be co-located. Adding a nurse to a community pharmacy can create a ‘walk in centre’ at a fraction of the cost.
- Build in. Before you ever consider creating a new layer of service delivery, ask the existing contractors what they can do or support to achieve your goals. Build in to existing services rather than ever considering building on top of. Why build outreach services to a population that already visit and connect with a Healthcare Professional.
There is strength in the community. There is strength in the assets that we commission within the community. Building and supporting those assets to deliver better care and more services is so important to both the financial security of the NHS and the ability to deliver better outcomes in healthcare and health promotion. Isn’t it just more sensible to invest in and strengthen the foundations of primary care, rather than a continual need to deliver increasingly expensive and complicated layers of healthcare? Can you imagine an NHS when the community pharmacy, the GP practice, the optometrist and the dentist were not in the community, on the high street, where people live?
People need to trust and use their community assets more. We need to invest and strengthen them so they can.
This blog is also available at the NHS Alliance web site